Application For Child Care Leave

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Name Of The Applicant : Designation :
Mobile 1: Mobile 2:
E-mail ID: Name of the Circle :
School name :
Date of first joining in service :
Date of Completion of 2 years continous and satisfactory service : Period of leave as applied for :      
  Days
Name Of the child : Date of Birth of the child :
Is the Child among the two eldest children : Any leave in credit (as on Date) :
Prefix of holidays, if any : Suffix of holidays, if any :
Total Child Care Leave availed till date : Date of returns from last leave & nature and period of that leave :
Application date : Signature :